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Illegal Organ Markets in Europe

A recent New York Times article laments the spread of illegal organ markets in Europe, in which mostly poor people try to sell kidneys and other organs to people who need transplants:

Facing grinding poverty, some Europeans are seeking to sell their kidneys, lungs, bone marrow or corneas, experts say…. The spread of illegal organ sales into Europe, where they are gaining momentum, has been abetted by the Internet, a global shortage of organs for transplants and, in some cases, unscrupulous traffickers ready to exploit the economic misery.

In Spain, Italy, Greece and Russia, advertisements by people peddling organs — as well as hair, sperm and breast milk — have turned up on the Internet, with asking prices for lungs as high as $250,000….

“Organ trafficking is a growth industry,” said Jonathan Ratel, a European Union special prosecutor who is leading a case against seven people accused of luring poor victims from Turkey and former communist countries to Kosovo to sell their kidneys with false promises of payments of up to $20,000. “Organized criminal groups are preying upon the vulnerable on both sides of the supply chain: people suffering from chronic poverty, and desperate and wealthy patients who will do anything to survive.”

The main supply countries have traditionally been China, India, Brazil and the Philippines. But experts say Europeans are increasingly vulnerable.

An estimated 15,000 to 20,000 kidneys are illegally sold globally each year, according to Organs Watch, a human rights group in Berkeley, Calif., that tracks the illegal organ trade.

The article notes various dangers of these markets, but mentions only obliquely and in passing that there is a massive worldwide organ shortage and that organ markets could save numerous lives. They could also help some of the world’s poor obtain much-needed income at little risk. The health risks of donating a kidney are far smaller than those associated with numerous jobs that no one argues we should ban the poor from taking, such as mining, lumberjacking, police work, and playing professional football. Moreover, the risk to poor donors would be much lower if organ sales were legal, and safety protocols were carried out by reputable legal buyers such as hospitals and insurers who would be liable for tort suits and breach of contract if they negligently put donors at risk.

Finally, it’s worth noting that if you really want to eliminate organ sales by the poor for fear they might be “exploited,” the best way to do so is to legalize sales by the nonpoor. As I explained back in 2009:

When I teach this issue in Property class, one suggestion I sometimes throw out to people who raise the exploitation issue is the possibility of limiting organ markets to nonpoor sellers. Wouldn’t the “problem” be solved by passing a law allowing organ markets, but limiting them to donors whose annual income exceeds some threshold (e.g. – the poverty line or the national average income)? Given that we have 300 million people and only need about 80,000 additional kidneys, a market that excludes the bottom 50% of the income distribution could still probably generate enough organs to eliminate the shortage, or at least a large part of it. Indeed, legalizing organ markets only for nonpoor sellers might actually reduce sales by the poor relative to the status quo, since it would wipe out much of the demand for black market organs (which are usually sold by poor people).

In my experience, those who raise the exploitation argument almost never endorse this proposal – despite the fact that it would eliminate any possible exploitation of the poor caused by legal organ markets without killing thousands of innocent people [as the current ban on organ sales does]…..

As in the case of drugs and alcohol, legalization is the the best way to eliminate the abuses associated with a black market. In this case, however, the case for legalization is strengthened by the fact that it would directly save thousands of lives that are lost every year because of organ shortages. Even during Prohibition, very few people ever died for lack of a drink. But many are dying right now because the ban on organ sales prevents them from obtaining organs they need to survive.

Today, on the Volokh Conspiracy blog, Ilya Somin trots out an even more extreme idea for decriminalization… creating a legal market in organs. Make it so that somebody who needs, say, an extra $10,000, can offer to sell a kidney on Craigslist. Somebody who needs a kidney can find one, pay the up-front cost, and get a new lease on life. I’m having a hard time finding the problem in his idea. I’m sure it’s there…

Legalization of organ sales does not mean that consumers will buy their organs directly from donors “on Craigslist” any more than legalized brain surgery means that patients hire brain surgeons on Craigslist. In both cases, patients are likely to get the services they need through expert intermediaries such as hospitals and insurance companies. The latter can assess the quality of the offered organs, address safety concerns, and address other issues that require expert judgment. They, not patients, are the ones who will do the actual initial purchasing of organs in a legal market. Many markets require the use of expert intermediaries in order to function effectively. That’s not an argument for banning them. Indeed, legalizing a market makes it much easier for institutional experts to provide needed services than ihey can in the present illegal market, where few experts are likely to become involved for fear of getting caught. Banning organ sales makes consumers more vulnerable to negligence and fraud, not less.